Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

J Gastroenterol Hepatol. 2012 Apr;27(4):813-22. doi: 10.1111/j.1440-1746.2011.07043.x.


Background and aim: Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritional-support could improve outcomes in cirrhotic patients.

Methods: Cirrhotic patients undergoing serial large-volume paracentesis for refractory-ascites were enrolled and randomized into three groups. Group A received post-paracentesis intravenous nutritional-support in addition to a balanced oral diet and a late-evening protein snack, group B received the same oral nutritional-protocol as the first group but without parenteral support, and group C (the control group) received a low-sodium or sodium-free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow-up.

Results: We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional-protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low-sodium or sodium-free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteral-nutritional-support than for the other two groups. In patients who were on the nutritional-protocol, there was a reduction in the requirement of taps for the treatment of refractory ascites.

Conclusions: Post-paracentesis parenteral-nutritional-support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver-cirrhosis that has been complicated by refractory-ascites.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Amino Acids, Branched-Chain / administration & dosage
  • Ascites / etiology
  • Ascites / therapy
  • Diet, Sodium-Restricted
  • Dietary Proteins / administration & dosage
  • Energy Intake
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology
  • Hepatic Encephalopathy / etiology
  • Hepatorenal Syndrome / etiology
  • Humans
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diet therapy
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / therapy*
  • Male
  • Middle Aged
  • Nutritional Status*
  • Paracentesis / adverse effects
  • Parenteral Nutrition
  • Peritonitis / microbiology
  • Proportional Hazards Models
  • Prospective Studies
  • Statistics, Nonparametric


  • Amino Acids, Branched-Chain
  • Dietary Proteins